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Femoroacetabular impingement syndrome is a disorder of the hip joint in which irregular contact occurs between the joint surfaces during motion, typically because certain hip shapes (cam or pincer morphology). In this thesis a systematic review demonstrated that the point prevalence of cam and pincer morphology was not known. This systematic review identified that there were no established diagnostic criteria for cam and pincer morphology. A consensus development conference was used to define FAI syndrome and how it should be diagnosed. This consensus conference was unable to establish the radiographic criteria to define cam and pincer morphology. A case control diagnostic study was undertaken to identify the optimal measures to identify cam and pincer morphology, using cross sectional imaging. These definitions were applied to a sample representative of the general population in order to determine the point prevalence of cam and pincer morphology. The same diagnostic criteria were applied to a group of professional golfers, in this population, asymmetry between left and right hips, and cam and pincer morphology were found to be associated with reduced hip related quality of life. A systematic review identified there was evidence to show that cam morphology caused hip osteoarthritis. However, the evidence to show that pincer morphology and FAI syndrome caused OA was presently lacking. No experimental studies were identified assessing whether treating cam and pincer morphology or FAI syndrome altered the risk of developing OA. A feasibility randomised controlled trial was conducted to determine whether proxy markers of osteoarthritis, measured on magnetic resonance imaging, could be used in a trial to determine whether surgery alters the natural history of FAI syndrome. |
